Four Substance Flesh-Releasing Decoction

The whole leaf is one substitution. Take the licorice out of Seungmagalgeun-tang, put scutellaria in, and a mild exterior-releasing decoction becomes a cooling one — which is the point, because the moment it is for is the moment nobody can tell what the child has. The section it hangs from says exactly that: in the first five days of fever, cold damage, pox, rash and epidemic illness look alike, and the instruction is to hold the middle with something acrid and cool rather than commit to warming or purging. That diffidence is the right instinct, and the problem it names is real. At the fever stage smallpox could not be distinguished from measles or from any other febrile exanthem; what settled it was the rash. Smallpox lesions were deep and firm, so that they could be felt under the finger, they came out all at the same stage at once, and they were heaviest on the face and the limbs; measles came as a blotchy running rash with the spots in the mouth that precede it. The chapter knows the first half of this — a few sections on it distinguishes pox from measles by exactly that test, whether the base is red and the top rounded and firm enough to catch the hand. Here it is still waiting. Nothing in the decoction treated either disease. Smallpox had no treatment; see gamipaedok-san-soa. Measles still has patients, and for measles the two things that matter are a safe and highly effective vaccine and vitamin A, which measurably reduces measles mortality in a child who has it. — Eui Young (Justin) Chung, L.Ac., Dipl. O.M.